Our aim was to estimate the date of the origin and the transmission rates of the major local clusters of subtypes A1 and B in Greece. Phylodynamic analyses were conducted in 14 subtype A1 and 31 ...subtype B clusters. The earliest dates of origin for subtypes A1 and B were in 1982.6 and in 1985.5, respectively. The transmission rate for the subtype A1 clusters ranged between 7.54 and 39.61 infections/100 person years (IQR: 9.39, 15.88), and for subtype B clusters between 4.42 and 36.44 infections/100 person years (IQR: 7.38, 15.04). Statistical analysis revealed that the average difference in the transmission rate between the PWID and the MSM clusters was 6.73 (95% CI: 0.86 to 12.60;
= 0.026). Our study provides evidence that the date of introduction of subtype A1 in Greece was the earliest in Europe. Transmission rates were significantly higher for PWID than MSM clusters due to the conditions that gave rise to an extensive PWID HIV-1 outbreak ten years ago in Athens, Greece. Transmission rate can be considered as a valuable measure for public health since it provides a proxy of the rate of epidemic growth within a cluster and, therefore, it can be useful for targeted HIV prevention programs.
Our aim was to investigate the dispersal patterns and parameters associated with local molecular transmission clusters (MTCs) of subtypes A1 and B in Greece (predominant HIV-1 subtypes). The analysis ...focused on 1751 (28.4%) and 2575 (41.8%) sequences of subtype A1 and B, respectively. Identification of MTCs was based on phylogenetic analysis. The analyses identified 38 MTCs including 2-1518 subtype A1 sequences and 168 MTCs in the range of 2-218 subtype B sequences. The proportion of sequences within MTCs was 93.8% (1642/1751) and 77.0% (1982/2575) for subtype A1 and B, respectively. Transmissions within MTCs for subtype A1 were associated with risk group (Men having Sex with Men vs. heterosexuals, OR = 5.34,
< 0.001) and Greek origin (Greek vs. non-Greek origin, OR = 6.05,
< 0.001) and for subtype B, they were associated with Greek origin (Greek vs. non-Greek origin, OR = 1.57,
= 0.019), younger age (OR = 0.96,
< 0.001), and more recent sampling (time period: 2011-2015 vs. 1999-2005, OR = 3.83,
< 0.001). Our findings about the patterns of across and within country dispersal as well as the parameters associated with transmission within MTCs provide a framework for the application of the study of molecular clusters for HIV prevention.
Objectives
HIV late presentation (LP) has been increasing in recent years in Europe. Our aim was to investigate the characteristics of LP in Greece using in addition to the traditional definition for ...LP, the time interval between HIV infection and diagnosis.
Methods
Our nationwide sample included HIV‐1 sequences generated from 6166 people living with HIV (PLWH) in Greece during the period 1999–2015. Our analysis was based on the molecularly inferred HIV‐1 infection dates for PLWH infected within local molecular transmission clusters of subtypes A1 and B.
Results
Analysis of the determinants of LP was conducted using either CD4 counts or AIDS‐defining condition at diagnosis or the time from infection to diagnosis. Older age, heterosexual transmission risk group and more recent diagnosis were associated with increased risk for LP. In contrast to previous studies, people who inject drugs (PWID) had a shorter median time to diagnosis (0.63 years) compared to men who have sex with men (MSM) (1.72 years) and heterosexuals (2.43 years). Using HIV infection dates that provide an unbiased marker for LP compared to CD4 counts at diagnosis, which are age‐dependent, we estimated that the time to diagnosis increased gradually with age. Migrants infected regionally do not differ with respect to LP status compared to native Greeks.
Conclusions
We demonstrate that older people and heterosexuals are among those at higher risk for LP; and given the growing number of older people among newly diagnosed cases, tailored interventions are needed in these populations.
Lung cancer is one of the leading causes of cancer-related deaths worldwide. Superior vena cava syndrome (SVCS) is a rare but potentially life-threatening complication of lung cancer, occurring in ...approximately 5-10% of cases. There are difficulties in the process of surgical treatment of SVC infiltrated by lung tumors but the contribution of technological evolution and innovation is promising. At the same time, the amelioration of survival rates of patients subjected to surgical treatment is equally promising. The reported outcomes of surgical treatment for SVC invasion due to lung tumors vary depending on the extent of the tumor and the patient's overall health status. However, studies clearly suggest that surgical treatment can improve survival and quality of life in selected patients. The literature review showed that the surgical approach to lung cancer invading the SVC constitutes the most indispensable treatment which helps to achieve the long-term survival of patients.
Background: Lung cancer, a leading cause of cancer-related mortality worldwide, often metastasises to the spine, resulting in significant morbidity and complex treatment challenges. The management of ...spinal metastatic disease from lung cancer necessitates a multidisciplinary approach, given the array of potential interventions including surgery, radiation therapy, chemotherapy, and supportive care. The selection of appropriate therapeutic strategies is influenced by multiple factors, including disease staging, patient health status, and symptomatology. Aim: This review article aims to explore the current landscape of surgical intervention for spinal metastases from lung cancer, evaluating its role, efficacy, and the criteria for patient selection within the context of multidisciplinary care. Additionally, it seeks to provide an overview of the existing treatment modalities, highlighting the importance of a tailored approach based on individual patient needs. Methods: An extensive review of the literature was conducted, focusing on studies, clinical trials, and meta-analyses published on the treatment of spinal metastases in lung cancer patients. Special attention was given to works discussing the surgical outcomes, prognostic factors, and the evolution of treatment protocols over recent decades. Results: Surgical treatment for spinal metastases from lung cancer is beneficial for select patients, particularly those without prior systemic treatments and those in good overall health. The decision to pursue surgery should be made within a multidisciplinary team, taking into account the patient’s specific situation and potential to benefit from the intervention. Research advancements and technological innovations continue to refine surgical techniques and improve patient outcomes. Conclusion: While the role of surgery in treating spinal metastatic disease from lung cancer is limited, it remains a critical option for appropriately selected patients. Future research should aim to further define and expand the criteria for surgical candidacy, enhancing the precision of patient selection and tailoring of treatment strategies. Emphasis on a multidisciplinary approach is essential for optimising outcomes and advancing care for patients with this challenging condition.
PDF
